Healthcare Provider Details

I. General information

NPI: 1598386278
Provider Name (Legal Business Name): NINA CAMILLE BURRUSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2020
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6430 ROCKLEDGE DR STE 500
BETHESDA MD
20817-1886
US

IV. Provider business mailing address

6430 ROCKLEDGE DR STE 500
BETHESDA MD
20817-1886
US

V. Phone/Fax

Practice location:
  • Phone: 301-562-8448
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number261569
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0100939
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: